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Progression to Pars Plana Vitrectomy in Patients With Proliferative Diabetic Retinopathy
TAKE-HOME MESSAGE
- In this study, the authors evaluated the rates of pars plana vitrectomy (PPV) in patients with proliferative diabetic retinopathy treated with panretinal photocoagulation (PRP) or anti-VEGF monotherapy. Patients treated with PRP monotherapy had higher rates of PPV at 1, 3, and 5 years (all P < .05). Additionally, patients treated with PRP monotherapy had a higher rate of vitreous hemorrhage (17%) compared with those treated with anti-VEGF therapy (10%). PRP monotherapy was associated with a 7% rate of tractional retinal detachment development compared with a 2% rate with anti-VEGF monotherapy.
- Patients treated with PRP monotherapy may be more likely to undergo PPV and experience higher rates of vitreous hemorrhage and tractional retinal detachment.
abstract
This abstract is available on the publisher's site.
Access this abstract nowIMPORTANCE
The Diabetic Retinopathy Clinical Research Network Protocol S suggested that vitrectomy for vitreous hemorrhage (VH) or tractional retinal detachment (TRD) was more common among eyes assigned initially to panretinal photocoagulation (PRP) vs anti-vascular endothelial growth factor (anti-VEGF) for proliferative diabetic retinopathy (PDR). These clinical implications warrant further evaluation in the clinical practice setting.
OBJECTIVE
To explore outcomes of PDR treated with PRP monotherapy compared with matched patients treated with anti-VEGF monotherapy.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective cohort study using an aggregated electronic health records research network. Patients with PDR who received PRP or anti-VEGF monotherapy between January and September 2023 were included before propensity score matching. Patients were excluded with 6 or fewer months' follow-up after monotherapy or with a combination of PRP and anti-VEGF. Data were analyzed in September 2023.
EXPOSURES
Patients with new PDR diagnoses stratified by monotherapy with PRP or anti-VEGF agents using Current Procedural Terminology code.
MAIN OUTCOME MEASURES
Incidence of pars plana vitrectomy (PPV), VH, or TRD.
RESULTS
Among 6020 patients (PRP cohort: mean [SD] age, 64.8 [13.4]; 6424 [50.88%] female; 3562 [28.21%] Black, 6180 [48.95%] White, and 2716 [21.51%] unknown race; anti-VEGF cohort: mean [SD] age, 66.1 [13.2]; 5399 [50.52%] male; 2859 [26.75%] Black, 5377 [50.31%] White, and 2382 [22.29%] unknown race) who received treatment, PRP monotherapy was associated with higher rates of PPV when compared with patients treated with anti-VEGF monotherapy at 5 years (RR, 1.18; 95% CI, 1.05-1.36; RD, 1.37%; 95% CI, 0.39%-2.37%; P < .001), with similar associations at 1 and 3 years. PRP monotherapy was associated with higher rates of VH at 5 years (relative risk [RR], 1.72; 95% CI, 1.52-1.95; risk difference [RD], 7.05; 95% CI, 5.41%-8.69%; P < .001) and higher rates of TRD at 5 years (RR, 2.76; 95% CI, 2.26-3.37; RD, 4.25%; 95% CI, 3.45%-5.05%; P < .001), with similar magnitudes of associations at 6 months, 1 year, and 3 years, when compared with patients treated with anti-VEGF monotherapy.
CONCLUSIONS AND RELEVANCE
These findings support the hypothesis that patients with PDR treated with PRP monotherapy are more likely to develop VH, TRD, and undergo PPV when compared with matched patients treated with anti-VEGF monotherapy. However, given the wide range in relative risk, confounding factors may account for some of the association between PRP vs anti-VEGF monotherapy and outcomes evaluated.
Additional Info
Disclosure statements are available on the authors' profiles:
Progression to Pars Plana Vitrectomy in Patients With Proliferative Diabetic Retinopathy
JAMA Ophthalmol 2024 Jul 01;142(7)662-668, AF Alsoudi, KM Wai, E Koo, R Parikh, P Mruthyunjaya, E RahimyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Alsoudi and co-authors reported the results from a retrospective cohort study that compared the clinical outcomes of panretinal photocoagulation (PRP) versus those of anti-VEGF intravitreal injection in patients with proliferative diabetic retinopathy (PDR). The current study utilized an electronic health records research network, which provided the largest sample size and the longest period of follow-up in the literature to date.
The current study reveals that patients with PDR treated with PRP may have a higher risk of requiring vitrectomy than those treated with anti-VEGF monotherapy. Therefore, the current data support previous observations in clinical trials, such as the Diabetic Retinopathy Clinical Research Network Protocol S and CLARITY studies, which were conducted in the setting of real-world clinical practice.
However, it is important to note that, when comparing patients with PDR treated with anti-VEGF injection versus PRP using the samples, owing to the de-identified nature of the database, it is more difficult to standardize how PRP was performed. Furthermore, it is impossible to verify any individual variation in PRP parameters. Therefore, the optimal guideline for the treatment of PDR with PRP versus anti-VEGF injection still requires further study.